JMIR Publications

ABSTRACT

Online appointment platforms are often viewed as tools of convenience, but ease of use does not necessarily mean equitable access. Online platforms may reproduce and potentially amplify health system inequities rooted in underlying structures such as insurance and reimbursement systems. In this study, the authors conducted an internet-based audit of appointments displayed on an online platform in Berlin, using simulated profiles representing patients with statutory health insurance (SHI) and private health insurance (PHI). On average, the time to the first available appointment was approximately 4 weeks longer for SHI than PHI patients; the PHI profile also had access to more than twice as many listings with appointments as the SHI profile. In an exploratory ranking analysis, listings offering earlier PHI than SHI appointments appeared higher in PHI search results than listings offering the same appointment timing to both profiles. Accounting for its strengths, limitations, and valuable opportunities for future research, the study suggests several policy implications. First, leaders should view online scheduling platforms as access infrastructure, not merely convenience tools, and evaluated them with respect to access and disparities, not only adoption and satisfaction. Second, future evaluation and work should treat access as multidimensional, assessing multiple measures of access and comparing online with other scheduling channels. Third, insurance and delivery reform should accompany actions to govern digital platforms, which can organize and display, but cannot alone eliminate, disparities rooted in reimbursement and care structures. Ultimately, the relevant question about online scheduling platforms is not only whether such systems make booking easier, but whether they narrow, preserve, or widen inequalities rooted in the broader health system. Digital front doors should be judged both by how easily they open and whether patients have equitable opportunities to pass through them.